Tetanus, Botulism, and Diphtheria

Aaron L. Berkowitz, MD, PhD Neuroinfectious Disease p. 1459-1488 October 2018, Vol.24, No.5 doi: 10.1212/CON.0000000000000651
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PURPOSE OF REVIEW: This article reviews the pathophysiology, epidemiology, clinical manifestations, diagnosis, and treatment of tetanus, botulism, and diphtheric neuropathy.

RECENT FINDINGS: Tetanus is most common in lower-income settings, but rare cases are seen in higher-income settings because of the inadequate maintenance of vaccination status. Foodborne botulism remains rare, but botulism can also be caused by IV drug use (wound botulism) and medical use of botulinum toxin (iatrogenic botulism); botulinum toxin has also been considered a potential agent of bioterrorism. Diphtheric neuropathy is rare but has been seen in recent epidemics in the former Soviet Union, and vaccination status is inadequate in a significant proportion of older individuals, creating the potential for subsequent epidemics.

SUMMARY: Tetanus, botulism, and diphtheric neuropathy are rare in higher-resource settings where most neurologists practice; however, familiarity with the unique clinical manifestations of and laboratory evaluation for these disorders is essential for the rapid diagnosis and treatment of patients with these conditions.

Address correspondence to Dr Aaron L. Berkowitz, Department of Neurology, Brigham and Women’s Hospital, 60 Fenwood Rd, Boston, MA, 02115, aberkowitz3@bwh.harvard.edu.

RELATIONSHIP DISCLOSURE: Dr Berkowitz receives publishing royalties from McGraw-Hill Education, MedMaster Inc, and Oxford University Press.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Berkowitz reports no disclosure.

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© 2018 American Academy of Neurology